BACKGROUND: The procedure of a simple hepatectomy and a hepatectomy with an extrahepatic bile duct resection and subsequent choledocho-jejunostomy is largely different. However, these two procedures are sometimes included in the same category. There are no studies comparing postoperative course and liver regeneration rate after a major hepatectomy with and without an extrahepatic bile duct resection. METHODS: We retrospectively reviewed medical records of 245 patients who underwent a right hepatectomy (RH, n = 55) or RH with an extrahepatic bile duct resection (RHEBR, n = 190)...

INTRODUCTION Biliary-enteric anastomoses are performed for a range of indications and may result in early and late complications. The aim of this study was to assess the risk factors and management of anastomotic leak and stricture following biliary-enteric anastomosis. METHODS A retrospective analysis of the medical records of patients who underwent biliary-enteric anastomoses in a tertiary referral centre between 2000 and 2010 was performed. RESULTS Four hundred and sixty-two biliary-enteric anastomoses were performed...

BACKGROUND: The biliary anastomosis remains to be the Achilles' heel of liver transplantation. The incidence of biliary complications (e.g., stenosis and leakage) is immanent and the optimal type of reconstruction is unclear. The aim of this study was to compare 2 different bile duct suture techniques regarding their benefits in the prevention of biliary complications. MATERIAL AND METHODS: From 1992 to 2012, the transplanted patients (n=394) of our center were analyzed retrospectively in terms of suture techniques and consecutive biliary complications...

BACKGROUND: An adult-to-adult living donor liver transplant (LDLT) has emerged as a possible option to help alleviate the organ shortage. The aim of this study was to analyze our experience with biliary complications in LDLT recipients and to identify their risk factors for biliary complications. This paper aimed to describe therapeutic interventions and to evaluate the impact of biliary complications on long-term patient and graft survival rates. METHODS: We evaluated biliary complications in a cohort of 120 LDLT recipients at a single institution and studied the impact on long-term graft and patient survival...

BACKGROUND: Pancreaticobiliary maljunction is a high risk factor of pancreatitis and biliary tract cancer. How this maljunction affects the liver remains obscure. This study aimed to examine the effects of pancreaticobiliary maljunction on the liver, pancreas and gallbladder in a cat model. METHODS: A model of choledocho-pancreatic side-to-side ductal anastomosis was created in ten cats. Before the procedure, a small piece of tissue from the liver, pancreas and gallbladder was collected as a control...

Endoscopic-retrograde cholangiopancreaticography (ERCP) is the method of choice for the treatment of surgical complications of the biliary system. Biliary leaks most frequently occur after cholecystectomy and partial liver resection. The most frequent complications after liver transplantation include biliary leaks, strictures and obstructive cholestasis. They are associated with significant morbidity and mortality as well as the risk of failure of the transplanted organ. The chance for a long-term successful therapy via ERCP is dependent on three main factors: (i) type, localisation and extent of the biliary damage, (ii) the time-point of appearance after surgery and (iii) the consequent accomplishment of the endoscopic therapy...

OBJECTIVES: This study reports the indications and outcome of various biliary bypass surgical procedures from a single centre over a period of 10 years. METHODS: This is a prospective observational study conducted over a period of 10 years (January 2001-december 2010). A total of 1500 patients were included, who underwent pancreatico-biliary surgery due to common bile duct (CBD) stones, congenital anomalies of biliary tree, unoperable pancreatico-biliary malignancies, CBD strictures and cases who developed iatrogenic biliary injuries during cholecystectomy (both open & laproscopic) during this period of time...

UNLABELLED: The purpose was to improve and refine our technique for orthotopic liver transplantation. MATERIAL AND METHOD: Experimental interventions were performed on pigs, 26 pairs. Orthotopic transplantation was performed after lavage of the donor pig liver by pressure gradient and transplantation was performed using portocavo- jugular shunt and veno-venous, arterio-arterial and choledocho-choledochal sutures in end-to-end manner. RESULTS: Immediate survival was 88...

BACKGROUND: Minilaparotomy has been reported to be an alternative minimally invasive option to laparoscopy. However, the quality of available data on the effectiveness of minilaparotomy to treat choledocholithiasis is poor. MATERIALS AND METHODS: Two hundred and twenty-eight patients with choledocholithiasis underwent surgical exploration of the common bile duct via minilaparotomy from 1995 to 2010. Of these, 193 patients had choledocho/cholecystolithiasis with previous ineffective attempts at endoscopic clearance and 29 patients had choledocho/cholecystolithiasis without previous attempts at endoscopic clearance...

BACKGROUND: The objective was to evaluate contrast enhanced ultrasound (CEUS) based cholangiography compared to conventional radiography as a reference method in patients after liver transplantation. MATERIAL/METHODS: Contrast agents were administered through T-tubes, which were placed during the operation. Twelve patients with side-to-side choledocho-choledochostomy and standardized intraoperative T-tube placement were investigated on the 5th postoperative day (POD 5) with both techniques...

The patient was a 71-year-old man. In September 2011, he experienced abdominal pain with high fever. Abdominal computed tomography (CT) diagnosed acute cholecystitis with a confluence stone (corlette classification type II). He underwent total cholecystectomy and placement of a T-tube in the main bile duct through the gall bladder duct. However, pathological investigations revealed gall bladder cancer in the neck and body part of the gall bladder, leading to a diagnosis of gall bladder adenocarcinoma(Gbn, Flat type, tub2, INF β,pSS, pHinf0, pBinf1, pPV0, pA0, pT3) with a confluence stone...

PURPOSE: Despite advancements in gallbladder surgery with the introduction of endoscopic and laparoscopic techniques, many surgeons, especially in the developing world, still perform open cholecystectomy with common bile duct (CBD) exploration for choledocholithiasis. The purpose of the study is to report the outcomes of a case series of open CBD exploration without the use of T-tubes. MATERIALS AND METHODS: A retrospective chart review of all consecutive open CBD exploration done by the first author over a period of 23 years was conducted...

The technical advances in endoscopic ultrasonograpy (EUS) and accessories have enabled performing EUS-guided intervention in the pancreas and biliary tract. Many research centers have been performing or investigating EUS-guided drainage, EUS-guided celiac plexus neurolysis and block, EUS-guided anastomosis that includes choledocho-enterostomy and choledocho-gastrostomy, EUS-guided ablation and injection therapy mainly for pancreatic neoplasm, EUS-guided photodynamic therapy and EUS-guided brachytherapy. Some of these are currently clinical applications and others are under investigations in clinical studies or animal models...

Pancreaticoduodenectomy includes choledochojejunostomy and pancreaticojejunostomy, which require hand-sewn anastomoses. Educational simulation models for choledochojejunostomy and pancreaticojejunostomy have not been designed. We introduce a simulation model for choledochojejunostomy and pancreaticojejunostomy created with a skin closure pad and a vascular model. A wound closure pad and a vein model (4 mm diameter) were used as a stump model of the pancreas. Pancreaticojejunostomy was simulated with a stump model of the pancreas and a double layer bowel model; these models were stabilized in an end-to-side fashion on a magnetic board using magnetic clips...

This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy...

BACKGROUND: US-guided hepatico - gastrostomy, choledocho-duodenostomy and choledocho-antrostomy are advanced procedures on biliary and pancreatic endoscopy and together make up the echo-guided biliary drainage. Hepatico - gastrostomy is indicated in cases of hiliar obstruction, while the procedure of choice is choledocho - duodenostomy in distal lesions. Both procedures must be done only after unsuccessful ERCP. AIMS: To clarify to the readers about indication of these procedures, they must be made under a multidisciplinary view while sharing information with the patient or legal guardian...

BACKGROUND: ERCP and PTCD are considered the gold standard in the interventional treatment of biliary obstruction, in particular, with palliative intention. If ERCP and PTCD are not possible, an alternative drainage procedure such as the EUS-guided cholangiodrainage (EUCD) can be used. AIM / METHOD: By the mean of a compact review, indication, technique, variants of approach, number of treated patients and therapeutic procedures reported by various authors, success rate, spectrum and management of complications as well as recommendations for an appropriate follow-up-investigation protocol for EUCD based on our own clinical experiences and compared to published data are described...